Healthcare Provider Details

I. General information

NPI: 1427611292
Provider Name (Legal Business Name): ELIZABETH HUTCHINSON CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 PERRY ST
DEFIANCE OH
43512-2123
US

IV. Provider business mailing address

7856 STATE ROUTE 108 LOT 32
WAUSEON OH
43567-9273
US

V. Phone/Fax

Practice location:
  • Phone: 419-782-9920
  • Fax:
Mailing address:
  • Phone: 419-410-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.170171
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: